Borderline Personality Disorder
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Around five million people with borderline personality disorder (BPD) are estimated to be living in the United States. Personality disorders are characterized by ways of seeing and reacting to others that can cause interpersonal and behavioral problems in life and relationships. Common signs of borderline personality disorder, in particular, include emotional instability and difficulty maintaining healthy connections with others. People with this condition may feel happy and positive and then sad and depressed a few hours later. Learning more about the treatments available for borderline personality disorder, such as dialectical therapy, may help you make an informed decision on your mental healthcare.
What is borderline personality disorder (BPD)?
Borderline personality disorder is a personality mental illness characterized by challenges controlling emotions that may cause significant disruption to a person's life during adolescence and young adulthood. Changes in regions of the brain involved in impulsivity, emotion control, and aggression may contribute to this condition.
According to the National Institute of Mental Health, challenges related to emotional control may impact self-esteem, and self-image issues, increase impulsivity, and negatively impact close relationships. Without treatment, people who are borderline personality disorder may experience depression, dangerous risky behavior (such as reckless driving), thoughts or actions related to self-harm, substance abuse, and/or suicidal behaviors and/or thoughts.
A 2018 study suggests there are common risk factors believed to lead to borderline personality disorder. Neurobiological abnormalities, a combination of specific genetic factors, and a history of childhood trauma may put you at a higher risk.
A 2018 study found that common factors believed to lead to BPD included brain abnormalities, genetic and environmental factors, and a history of childhood trauma.
How is Borderline Personality Disorder (BPD) diagnosed?
Borderline personality disorder is often diagnosed and treated after age 18. This is because an individual’s personality typically evolves so significantly throughout childhood and adolescence that providing an accurate diagnosis of a personality disorder in these phases of life can be difficult. Many children or teens who will go on to receive a borderline personality disorder diagnosis as adults may be initially diagnosed with depression or anxiety disorders in their younger years. A licensed mental health professional can diagnose the condition through interviews and observations of both the individual and family history.
Therapists and psychiatrists typically look for the following symptoms when considering a diagnosis of borderline personality disorder and other mental disorders:
- A fear of abandonment
- Emotional pain related to actual or imagined loss of significant relationships
- Unstable emotions and/or challenges controlling intense emotions
- Unstable self-image
- Traumatic life events
- Intense and unstable relationships with friends and family members
- Self-destructive relationship habits
- Difficulty holding a job for an extended period
- Risky, impulsive behavior like unsafe sex or uncontrolled spending
- Self-harm
- Suicidal thoughts
- Difficulty managing stress
- Intense anger and/or irritability
- Dissociation (feeling "out of your body")
- Rapid mood swings
- Significant stress-related paranoia
- Ongoing feelings of depression or anxiety
- Feeling persistently bored or empty
- Challenges understanding one's identity or personality
- Cycling patterns of recognizing and denying the value of one's relationships often referred to as "splitting"
Developing borderline personality disorder (BPD) may also occur alongside another mental health condition, including the following:
- Anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Complex post-traumatic stress disorder (C-PTSD)
- Sleep disorders
- Eating disorders, including binge eating
- Depression
- Substance use disorders
- Suicidal behavior
- Bipolar disorder
- Narcissistic personality disorder (NPD)
Psychotherapy, or talk therapy, is considered the cornerstone of BPD treatment according to the National Alliance on Mental Illness (NAMI). A comprehensive health treatment plan for borderline personality disorder may include a combination of psychotherapy and specific work to repair social factors alongside a clinical social worker or other mental health professionals. A mental health provider may also recommend medication to help manage severe symptoms for some disorders. Do not start, stop, or change any medication without consulting a psychiatrist or other healthcare provider who can manage your psychiatric management plan. Types of therapy that are commonly recommended for those who develop borderline personality disorder (BPD) are listed below.
Borderline personality disorder is often treated through DBT, which is a form of cognitive-behavioral therapy (CBT) focused on the impact of your beliefs, thoughts, and behaviors, emphasizing mindful living and acceptance to manage symptoms. This type of therapy (DBT) is usually a structured program that involves a workbook, worksheets, and frequent sessions. It can be done in an individual or a group therapy format and was developed specifically to treat borderline personality disorder by Dr. Marsha Linehan. It involves four modules, including:
- Emotional control
- Distress tolerance
- Mindfulness skills
- Interpersonal effectiveness
The authors of a journal publication on DBT for borderline personality disorder state that "dialectical behavior therapy is based on cognitive-behavioral principles and is currently the only empirically supported treatment for BPD. Randomized controlled trials have shown the efficacy of DBT not only in borderline personality disorder but also in other disorders, such as substance use disorders, mood disorders, post-traumatic stress disorder, and eating disorders."
Borderline personality disorder symptoms may lead to distress within a family dynamic. Family therapy can be a potential long-term therapeutic plan for individuals such as parents, siblings, partners, or mothers with borderline personality disorder who often feel emotionally unstable and experience difficulty maintaining healthy relationships. Through family counseling, individuals with borderline personality disorder and their immediate family can meet with the therapist together to discuss behavioral and emotional interventions and learn healthy coping skills and communication strategies.
Schema therapy can be effective for people with other personality disorders who may not respond to other treatments as it’s a combination of elements from multiple forms of therapy. In schema therapy, the therapists focus on targeting your schema, or a pattern of unwanted thoughts, to reduce self-destructive personality behaviors that may have developed during childhood.
Cognitive behavioral therapy is backed by significant research suggesting its effectiveness in treating various mental health conditions, including borderline personality disorder. This therapy focuses on identifying unwanted or harmful thought patterns, behaviors, and perceptions of self and others and developing strategies to shift them.
Researchers believe that TFP treatments may help those with borderline personality disorder (BPD) who experience a split optimistic and pessimistic view of themselves and their primary caregiver due to excessive childhood aggression. TFP aims to merge the positive and negative perspectives of personality to form a realistic view of the self and others.
In addition to working with your mental healthcare provider to develop a plan to treat specific symptoms, there are various coping skills and lifestyle changes you might use to manage your symptoms and adjust to living with borderline personality disorder, including the following:
- Journaling
- Building distress tolerance
- Practicing mindfulness
- Identifying accountability
- Working self-focused time into your routine
- Practicing yoga or other forms of calming movement
- Distracting yourself with sensory stimulation
- Not assuming intentions
- Caring for your physical health
- Taking walks in nature
If someone you love has been diagnosed with borderline personality disorder, there are several ways you can support them, including the following:
Learn about borderline personality disorder
If your family or partner has borderline personality disorder, attending family or couples therapy together could help strengthen your bonds and teach you both helpful coping strategies for communication, connection, and crisis response.
In the end, it’s the choice of the individual with borderline personality disorder whether or not to attend therapy or seek other treatments for their condition. However, it could be beneficial for you as their loved one to gently encourage them to seek or stick with treatment long-term. Knowing that they have your support through the process could help them start or stay the course.
Finding a balance between supporting your loved one and caring for yourself can be crucial. This can look like setting and enforcing boundaries related to your space, belongings, body, and time. for one. If you feel you could benefit from support with this or another aspect of loving someone with borderline personality disorder, speaking to a therapist yourself may be beneficial.
If you experience trouble maintaining healthy relationships, feelings of emptiness, an intense fear of abandonment, poor impulse control, and/or other symptoms of borderline personality disorder, you might consider reaching out to a therapist for guidance. If you face barriers to treatment like cost, distance, or lack of availability, online counseling for BPD could represent a more convenient option.
Borderline personality disorder is a mental illness that can come with challenging and emotionally distressing symptoms. Mental health counseling with an online or in-person therapist may help reduce the chances of a psychiatric hospital visit in clients with personality disorders. If you're ready to explore your options, you might consider reaching out to a therapist for compassionate insight and support.
To overview borderline personality disorder, it is a mental health disorder in which a person has difficulty regulating their emotions and exhibits impulsive and dangerous behaviors. Because of this, people with BPD often have difficult or intense relationships with others. People with BPD may experience paranoid thoughts or chronic feelings of inadequacy.
What can cause borderline personality disorder (BPD)?
A variety of factors can cause BPD in a person’s personality development. If someone has a family medical history that includes mental disorders such as BPD, a person can be more likely to develop bpd. Differences in brain structure in areas that control emotion also can contribute to development of BPD. Experiencing child abuse or
parental substance use or substance use disorder can also contribute to BPD. BPD is usually diagnosed in the late teens or early adulthood.
What is the best form of therapy for borderline personality disorder?
Once a mental health professional has borderline personality disorder diagnosed, they will recommend treatment. Borderline personality disorder treated with dialectical behavior therapy often has the best results. Dialectical behavior therapy helps people become more aware of their mental processes. It involves validation of feelings and verification successful waiting before acting.
Therapy for borderline personality disorder is typically a long-term process. It can take a year or more to see significant progress with BPD symptoms.
BPD cannot be treated with medication alone, although some medications such as antidepressants and mood stabilizers can be helpful for people with BPD. The best way to treat BPD is with dialectical behavior therapy.
No, borderline personality disorder can’t be cured without therapy. In fact, people with BPD who don’t receive therapeutic services are at increased risk of substance misuse, self harming behavior, and depression.
No, it is not possible to self-treat BPD. A person with borderline personality disorder requires therapeutic support to manage symptoms and improve mental health. Emotional support from a therapist is important for managing symptoms of BPD in everyday life. However, a person with BPD can practice techniques they learn from a therapist on their own outside of therapy sessions.
Untreated BPD is one of the risk factors for other mental health conditions and self harming behaviors, especially if a person experiences overlapping symptoms.
Is it difficult to treat borderline personality disorder?
One reason why therapists find it difficult to treat people with BPD is that the clients may not have trust in interpersonal relationships and may therefore try to sabotage the relationship with the therapist. Erratic behaviors that some people with BPD display may make them not show up to appointments, argue with the therapist, call them often, or not pay their fees. Dangerous behaviors on the part of the client, and therapist worries about client self harm can also be difficult for a therapist.
Two things that can help you calm down are identifying your triggers and finding distractions so that you don’t become overwhelmed with extreme emotions. If you locate the site properly of your emotions, you can become more aware of them. If you notice that you’ve been triggered, you can train yourself to wait a few seconds before you make a decision to speak or act.
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